Effect Of Perioperative Antiviral Therapy On Postoperative Prognosis Of HBV DNA-negative Patients With HBV-related Hepatocellular Carcinoma

Objective:To explore the effect of perioperative antiviral therapy on the prognosis of patients with HBV-related hepatocellular carcinoma(HCC)who were negative for preoperative HBV DNA.Methods:A total of 140 HBV DNA-negative patients with HBV-related HCC who were first diagnosed at the hepatobiliary surgery department of Guangxi Medical University Cancer Hospital between August 2013 and August2016 and treated with partial hepatectomy were divided into an observation group(60 patients)and a control group(80 patients),and the observation group received perioperative(3 days before operation to at least 1 month after operation)antiviral therapy,and none of the control group received any antiviral therapy preoperatively and postoperatively.The two groups were matched 1:1by propensity score matching(PSM)to analyze the rate of postoperative HBV reactivation as well as postoperative liver function in the two groups,and logistic regression was used to identify independent risk factors associated with the prognosis,and the recurrence-free survival(RFS)and overall survival(OS)rates at 1-,2-,and 3-years after surgery were compared between the two groups by the Kaplan Meier method and compared by the log rank test.Results:Postoperative HBV reactivation occurred in 1(1.7%)and 12(15.0%)patients in the observation and control groups,respectively(P = 0.007).The observation group had lower child-Pugh scores than the control group at postoperative month 1(5.04 ± 0.20 vs.5.26 ± 0.60,P = 0.010).However,there was no significant difference in the Model for End-Stage Liver Disease(MELD)scores between the two groups at any postoperative time point(P > 0.05).Before PSM,the postoperative 1-,2-,and 3-year RFS of observation and control groups were 67.0%,51.0%,35.8%,and 45.7%,27.9%,27.9%,respectively(P =0.037),and the corresponding OS was 96.6%,86.2%,82.2%,and 85.0%,69.5%,57.6%,respectively(P = 0.002).After PSM,the 1-,2-,and 3-year RFs rates were 64.5%,50.6%,33.7%,and 48.9%,25.3%,25.3% in the observation and control groups,respectively(P = 0.035);The corresponding 1-,2-,and 3-year OS rates were 96.3%,87.0%,82.7%,and 85.7%,71.2%,60.2%,respectively(P= 0.003).Results of the prognostic analysis excluding HBV reactivation showed that perioperative antiviral therapy can significantly improved OS(P = 0.004)but was not associated with improved RFS(P = 0.056).Multivariate analysis showed that microvascular invasion(MVI)(OR = 2.557,95% CI: 1.140-5.733,P = 0.023] was an independent influence factor of tumor recurrence and perioperative antiviral therapy(OR = 0.356,95% CI: 0.135-0.990,P = 0.048)was an independent influence factor of postoperative survival.Conclusion : For HBV-related HCC patients who are negative for preoperative HBV DNA,perioperative antiviral therapy can reduce the rate of postoperative HBV reactivation,improve liver function,reduce the risk of tumor recurrence,and prolong survival.